Because Hlengiwe knew that HIV can be transmitted through breast milk, she had decided not to breastfeed (as had all the women I interviewed). The probability of transmitting the virus while breastfeeding depends upon a number of factors and is reduced if exclusive breastfeeding is undertaken (Coutsoudis, 2005). There is some debate regarding whether women should be discouraged from breastfeeding or not. Exclusive breastfeeding is difficult to adhere to in economically challenged environments (Thairu et al., 2005), but it has been argued that the advantages of breast milk for overall mortality outweigh the risks of possible infection (Bland et al., 2002; Coutsoudis et al., 2003). This dilemma is complicated by beliefs and practices. For example, Kruger and Gericke (2003) found that all their research participants believed that breast is best (thereby problematising the use of formula feed), but none believed in exclusive breastfeeding. Hlengiwe, like most of the women interviewed, was not aware of this debate, but had definitively decided not to breastfeed. She was worried, however, that this would be interpreted as a sign that she is a bad mother or as an indication that she is HIV-positive. It is culturally expected that an African woman should breastfeed openly in public, and this is understood as the quintessential sign of being a good mother. For many women, this complicated their construction of themselves as ‘good mothers’. They were also criticised by family members for being bad mothers. The cultural breast defines the mother; a woman who chooses not to breastfeed is choosing to reject her culture. Even for women who resisted cultural discourses, the cultural imperative to breastfeed had to be addressed. One woman, for example, said she wasn’t affected by not breastfeeding, because she had always felt that black women who breastfeed in public do not respect their bodies. Her way of justifying her decision to me could not be done without reference to culture. The cultural implications of choosing not to breastfeed are further complicated by the social assumptions that women who do not breastfeed are HIV-positive. Hlengiwe was scared that her secret would be exposed by her choice not to breastfeed, but felt that she had no other choice. In terms of the cultural definition of motherhood, many felt personally bereft of feeling like mothers.
Hlengiwe planned to conduct another interview with me, but cancelled at the last minute because she wanted another woman, who was contemplating adoption, to do an interview instead. She did not want me to contact her for fear of arousing suspicion. I did not see her in the postnatal clinic and she did not contact me. Like all the stories in this study, my telling of it is incomplete.
Pumla
Pumla, unemployed, conducted an interview with me when she was eight months pregnant and again when her son was three months old, before she knew his status. Her appearance was neat and her dress demure. She did not see herself as a ‘modern woman’, as did Hlengiwe. Pumla was diagnosed HIV-positive when she was three months pregnant. At the time, she was living with her boyfriend of ten years, the only person with whom she had had a sexual relationship. This relationship was stable, but violent; she described how he was hypervigilant of her actions and showed me a scar on her face where he had hit her with a gun. She was not the only woman to describe domestic violence: South Africa has one of the highest domestic and sexual violence rates in the world. Pumla had been concerned that her boyfriend had other sexual partners and, before being diagnosed, had thought about asking him to use a condom. However, she was too scared to do so. Strebel (1997) suggests that South African women are caught in a paradox in which they are expected to take responsibility for safe sex, but are often powerless to do so. The ‘good’ woman should avoid becoming HIV-positive by maintaining self-control, self-discipline and responsibility (Sacks, 1996). In everyday negotiations, however, expecting women to take responsibility for their sexuality ignores the asymmetry of heterosexual relationships (Kippax et al., 1990). This has particular resonance in Africa, where women have little access to sexual negotiating power (Lawson, 1999). A woman who requests condom use, for example, is likely to be accused of being HIV infected or promiscuous, or of accusing her partner of infidelity (Santow, 1995), the consequences of which can be violent and can lead to economic hardship (Strebel, 1992). This is precisely what Pumla was scared of. Urging South African women to ask their men to use condoms ignores male suspicion of condoms (Maharaj, 2001), as well as the interaction between male power and discourses of love for women, where women may accept what men want because they love them (Hoosen & Collins, 2004). Further, AIDS campaigns often reinforce the sanctity of faithful heterosexual relationships (Seidel, 1990) without acknowledging double standards in which male promiscuity is acceptable or situations in which multiple sexual partners may signify masculinity (Walker, Reid & Cornell, 2004). In circumstances such as these, a woman’s faithfulness, such as Pumla’s, to her partner therefore often fails to protect her from HIV infection (Lawson, 1999).
When Pumla told her boyfriend that she was positive, he ‘chased’ her away, ‘and he said to me, “if you call me and accuse me of that, you’re wasting your time. You can see me that I’m happy, I’m healthy, I’m okay”’. He accused her of becoming infected through ‘sleeping around’ and denied any possibility that he may be infected. He had seen the baby once since he was born, but denies paternity.
Left with nowhere to live, Pumla approached her mother and disclosed her status. At first her mother was supportive, but, when her baby was a few days old, told her to leave and not come back: ‘I’m finished with your child.’ Pumla thinks that her mother assumed that she and her baby would become sick immediately and did not want the scandal associated with an AIDS-related death, that her mother blamed Pumla for becoming infected, and that ‘it’s my fault, because I didn’t listen to her’. When I asked what her relationship with her family had been like before her diagnosis, she said that she was ‘very, very close’ to her mother:
You see, I was working and I didn’t have a baby, you know. It was my mother, and my mother she is a pensioner, and my brother and my sister, né, who stay with my mother. So my mother, she loved me very, very, very much, because each and everything that I do, when I buy groceries, I buy groceries for my mother, because I’m working and I have money. Every time when I bought something, it’s for my mother, because I know that my brother he’s drinking, you see all these things, and my sister can’t help my mother. Everything was very, very good; me and my mother got on well.
This illustrates the cultural importance of supporting one’s family, a value shared by most participants, whether they lived with family or not. For Pumla, however, this support was not reciprocated and she was forced to live on her own. This was particularly hurtful for her, given the culturally accepted practice that a woman lives with her mother after a baby is born so her mother can help with the first stages of childrearing and protect her in the maternal home. Even women who lived with their partners were expected to go to their mothers’ homes for a period post-partum. In reality, however, few women were able to do this, either because their mothers lived far away, were old or had died; because they had difficult relationships with their mothers; or because they were stigmatised and rejected because of their HIV status, as in Pumla’s case.
Although some women were supported after disclosing their HIV status, all the women interviewed experienced some stigma. This was sometimes a direct result of disclosing their status, but was sometimes indirect. Numerous examples were cited of women overhearing or participating in conversations about HIV with people who did not know that they were positive and being hurt by the prejudiced comments people made. Pumla describes a typical example in which this prejudice is combined with assumptions about motherhood:
Whenever these people they talk about HIV and AIDS [and] they think people [are] with HIV, people like to talk very, very, very bad things about HIV people. Sometimes they say, ‘oh, I don’t like these people. If maybe somebody can come into my house and say they’re HIV-positive, I can say, ‘no you must go’. Then I said to this person, ‘if I can tell you that I’m HIV-positive, what are you going to do?’ He said to me, ‘no, I can see that you are clean. You’ve got a small child. If you were having HIV, people with HIV, the children they die, so I can see your baby is growing normally and you’re healthy